Immunodiagnostic Potential of an In-Vitro Interferon-Gamma Release Assay for Latent Tuberculosis Infection Among Apparently Healthy Individuals in Okada Community, Nigeria
International Journal of Immunology
Volume 5, Issue 3, June 2017, Pages: 41-48
Received: Mar. 4, 2017;
Accepted: Mar. 24, 2017;
Published: May 9, 2017
Views 2640 Downloads 147
Benson Olu Akinshipe, Departments of Medical Microbiology, School of Clinical Medicine, College of Health Sciences, Igbinedion University & Igbinedion University Teaching Hospital, Okada, Nigeria
Peter Chinedu Ezeani, Kamorass Specialist Clinics Laboratories, Victoria Island, Lagos, Nigeria
Kester Awharentomah Digban, Department of Medical Laboratory Science, College of Health Sciences, Igbinedion University, Okada, Nigeria
Friday Alfred Ehiaghe, Department of Hematology, College of Health Sciences, Igbinedion University, Okada, Nigeria
Emmanuel Babatunde Adedeji, Environmental Biology Research Unit, University Of Ibadan, Ibadan, Nigeria
Joy Imuetinyan Ehiaghe, Lahor Research Laboratory and Medical Centre, Benin City, Nigeria
A major challenge in the global Tuberculosis (TB) control is the diagnosis and treatment of Latent Tuberculosis Infection (LTBI). In the absence of any reference standard test for the diagnosis of LTBI, this study set out to compare the performance of the two current immune-based tests, Tuberculin Skin Test (TST) and Quantiferon–TB Gold In–Tube (QFT-GIT) ELISA in the diagnosis of LTBI. Two sets of diagnostic results for 196 apparently healthy volunteers from a cross-section of Okada Community, Edo State, Nigeria were compared in terms of age, occupation, BCG-vaccination status, prior TST and cigarette smoking history. Overall, 56 (28.6%) and 81 (41.3%) of the subjects were diagnosed with LTBI by the QFT-GIT test and TST respectively. The LTBI prevalence as assessed by the QFT-GIT test was significantly higher among the non-BCG-vaccinated, compared to the BCG-vaccinees (X2=18.79, df=1, p=0.0001). The highest concordance (QFT-GIT+ve/TST+ve) was found in the occupation categories (Ʀ=-0.009, p=0.747) and the highest discordance(QFT-GIT –ve/TST +ve) was with respect to the BCG-vaccination status (Ʀ=-0.194, p=0.046).The disparity in the performance of the two tests is attributable to the high false – positive TST results, which is a direct reflection of high (90.8%) BCG vaccination level among the study population. It is advocated that the two-step testing approach, using the QFT-GIT assay as a confirmatory test for LTBI after initial positive screening by the TST, be introduced into the TB control strategy in TB – laden communities with high BCG vaccination coverage.
Benson Olu Akinshipe,
Peter Chinedu Ezeani,
Kester Awharentomah Digban,
Friday Alfred Ehiaghe,
Emmanuel Babatunde Adedeji,
Joy Imuetinyan Ehiaghe,
Immunodiagnostic Potential of an In-Vitro Interferon-Gamma Release Assay for Latent Tuberculosis Infection Among Apparently Healthy Individuals in Okada Community, Nigeria, International Journal of Immunology.
Vol. 5, No. 3,
2017, pp. 41-48.
World Health Organization (WHO) Tuberculosis Report (2016). http//www.who.int/mediacentre/factsheets/fs104/en /
World Health Organization. Global tuberculosis control: epidemiology, strategy, financing: WHO report 2009. Geneva, Switzerland: World Health Organisation 2009. Available at http://www.int/tb/publications/global report/2009/pdf/report.
Nigeria Tuberculosis Fact Sheet (2012). http://nigeria.usembassy.gov
Collins HL, Kaufmann SHE. Acquired immunity against bacteria. In: SHE Kaufmann, A Sher, R Ahmed (Eds.).Immunology of infectious Diseases. ASM Press, Washington DC 2002. Pp 207-221. Chapter 15
Schluger N.W. The pathogenesis of tuberculosis: the first one hundred (and twenty- three) years. Am. J. Respir Cell Mol. Biol. 2005; 32: 251 – 256
Shakak AO, Khadil EAG, Musa AM, Salih KAM et al. Possible risk factors of progression to overt disease among individuals with latent tuberculosis infection in the Sudan. IJCR. 2013: 13: 1107-1110.
PaiM, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann lntern Med 2008 ; 149: 177-184
Lavlani A, Pareek M. A 100 year update on diagnosis of tuberculosis infection. Br.Med: Bull 2010; 93: 69-84.
Pinto LM, Grenier J, Schumacher SG, Denkinger CM, Steingart KR, Pai M. Immunodiagnosis of Tuberculosis: State of the Art. Med. Princ. Pract. 2012;21:4-13
Babayigit C, Ozer B, Inandi T, Ozer C, Duran N, Gocmen O. Performance of QuantiFERON-TB Gold in –Tube test and Tuberculin Skin Test for diagnosis of latent tuberculosis infection in BCG vaccinated health care workers. Med Sci. Monit. 2014, 20: 521-529.
Mazurek GH, Jereb J, Vernon A, Loblue P et al. CDC updated guidelines for using interferon gamma release assays to detect mycobacterium tuberculosis infection- United States, 2010. MMWR Recommd. Rep 2010; 59: 1-25.
Lucas M, Nicol P, Mckinnon E, Whidborne R, Lucas A et al. A prospective large-scale study of methods for the detection of latent mycobacterium tuberculosis infection in refugee children. Thorax. 2010, 65(5) 442-448.
Diel R, Goletti D, Ferrara G, Bothamley C et al. Interferon –gamma release assays for the diagnosis of latent mycobacterium tuberculosis infection: a systematic review and meta-analysis. Eur Respir J. 2011;13: 88-99
Adewole OO, Erhabor GE, Sogaolu MO, Onipede AO, Owiafe PK, Awopetu FO, Ota MO. Diagnostic utility of Quantiferon-TB Gold in-tube in active pulmonary Tuberculosis in Nigeria. West Afr J Med.2013, 32 (3): 180-185.
Nakaoka H, Lawson L, Bertel Squire S, Coulter B et al. Risk for Tuberculosis among children. Emerg Infect Dis 2006; 12 (9): 1383-1388.
American Thoracic Society. Targeted tuberculosis testing and treatment of latent tuberculosis infection. Am J. RespirCrit Care Med 2000; 161: S221-S247.
Reider HL, Chadha VK, Nagelkerke NJD, van Leth F, van der Werf M.J: Guidelines for conducting tuberculin skin test surveys in high prevalence countries. Int J Tuberc Lung Dis 2011; 15:S1-26.
Adetifa IM, Ota MO, Jeffries DJ, Hammond A, Lugos M.D et al. Commercial interferon gamma release assays compared to the tuberculin skin test for diagnosis of mycobacteria tuberculosis infection in childhood contacts in the Gambia. Pediatr Infect. Dis J. 2010; 29 (5): 439.
Kang YA, Lee HW, Yoon H I et al. Discrepancy between the tuberculin skin test and the whole-blood interferon-gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA (2005), 293, 2756-2761.
Legesse M, Ameni G, Mamo G, Medhin G et al. Performance of Quantiferon-TB Gold In-Tube (QFT-GIT) for the diagnosis of mycobacterium tuberculosis (MTb) infection in Afar Pastoralists, Ethiopia. BMC infectious Diseases, 2010, 10:354.
Shanaube K, Hargreaves J, Fielding K, Schaap A et al. Risk factors Associated with Positive QuantiFERON-TB Gold In-Tube and Tuberculin Skin Tests Results in Zambia and South Africa. PLoS one, 2011, vol 6.No4, 18206.
Farhat M, Greenaway C, Pai M, Menzies D. “False-positives tuberculinskin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria?” International J of Tuberculosis and Lung Disease 2006, vol. 10 no 11, pp 1192-1204.
Nienhaus A, Ringhausen PC, Costa J. T, Schabion A, Tripodi D. IFN- gamma release assay versus tuberculin skin test for monitoring TB infection in healthcare workers Expert Rev. Anti. Infect. Ther.2013; 11 (1), 37
TrajmanA, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin skin Testing for the diagnosis of Latent Tuberculosis infection: An overview of the evidence. Pulmonary Medicine, vol.2013 (2013)
Choi JC, Shin JW, Kim JY et al. The effect of previous tuberculin skin test in the follow-up examination of whole-blood interferon-gamma assay in the screening of latent tuberculosis infection. Chest 2008; 133: 1415-1420.
Drobniewski F, Balabanova Y, Zakamova E, NiIkolayevskyy V, Fedonn I (2007). Rates of latent tuberculosis in health care staff in Russia. PLoS Med.4 (2). 55.
Menzies D “Interpretation of repeated tuberculin tests: boosting, conversion and reversion”. Am J RespirCrit Care Med, vol. 159, no 1, pp. 15-21, 1999. View at Google scholar.
Mirtskhulava V, Kampker R, Leonard MK, Tsertsvadze T, Diel R et al. Prevalence and risk factors for latent Tuberculosis infection among health care workers in Georgia. Int J. Tuberc Lung Disease 2008. 12; 513-519.
Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis. 1993; 13: 968-975. doi 101093/clinds/17.6.968.
Higuchi K, Kawabe Y, Mitarai S,Yoshiyama T, Harada N, Mori T. “Comparison of performance in two diagnostic methods for tuberculosis infection”, Medical Microbiology and Immunology. 2009, vol. 198, no 1, pp 33-37.
Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile, et al. “Predictive value of interferon-gamma release assays for incident active tuberculosis: a systematic review and meta-analysis”, The Lancet Infectious Diseases 2012; vol 12. No. 1, pp 45-55.
Quantiferon-TB Gold (in-tube method). Package insert. March 2013. Retrieved from Cellestis website. http://www. Cellestis. com/IRM/ company/show page. aspx (cpin-1171)